A Guide to Helping Individuals with Schizophrenia Thrive

Schizophrenia, with a lifetime prevalence of 1.41% and a current prevalence of 0.42% (Hegde, Nirisha, 2023), is a disorder of brain development that affects how a person thinks, feels, and behaves. The spectrum of schizophrenic disorders is characterised in general by fundamental and characteristic distortions of thinking and perception, and by inappropriate or blunted affect (ICD-10). Schizophrenia is a complex mental condition in which a person's experience of reality is often blurred from what is imaginative. This can be distressing for them and especially for their family and friends. The symptoms of schizophrenia make it challenging for the patients to participate in usual, everyday activities. 

Individuals with schizophrenia experience varying symptoms, including delusions, hallucinations, abnormal psychomotor behaviour, depression, anhedonia, catatonia, and cognitive impairment. Delusions are false and strongly held beliefs that do not change despite being challenged with clear evidence that shows otherwise. Hallucinations occur when they see, hear, smell, taste or feel things that aren't there; these experiences feel very vivid and real, which makes it difficult for them to differentiate between what is a hallucination and what is reality. They may also behave in unusual ways, including engaging in repeated movements, acting childlike and unpredictable outbursts of anger. People with schizophrenia also often have difficulty expressing their emotions, may choose to stay isolated, display apathy, and feel a lack of drive to engage in goal-directed actions. In addition to this, their speech may sound jumbled or they may constantly shift from one topic to another that isn't related, which severely affects their ability to communicate effectively.

Like all other mental health conditions and illnesses, schizophrenia exists beyond clinical understanding and diagnosis and involves a narrative shaped by culture, history, and misunderstanding in the context of human experience and societal dynamics. Throughout human civilization, mental illness has been looked at through the lens of fear, mystery and even moral judgment. Although the advent of mental institutions promised care, it almost always devolved into places of neglect and abuse, leading to poor mental hygiene and ill-treatment. 

Strategies to help a person with schizophrenia

Empathy and patience

Empathy. It's a word and an approach that is beyond sympathy and pity and truly requires putting oneself in the other person's shoes to understand another perspective. Supporting someone with schizophrenia involves fostering empathy, patience, and an open, non-judgmental mindset. Recognise that their experiences and perceptions of reality may be shaped by their symptoms, which can sometimes feel bewildering or isolating. Rather than dismissing their feelings or perceptions, offering a compassionate, understanding presence can be profoundly validating and contribute to their path toward stability and well-being. 

Managing crises

For a caregiver, handling crises for a patient with schizophrenia might be overwhelming and confusing. This is because, during an acute episode, the symptoms of psychosis become frightening for a caregiver, as the person is unable to tell the difference between reality and their imagination. In such a situation, the individual may exhibit aggression due to extreme paranoia or as a response to threatening hallucinations. Hence, managing any form of crisis becomes crucial.

During a crisis, prioritising safety—both for the individual and those around them—is critical. Taking swift but measured actions can prevent harm and create an environment where the individual feels secure.

Remaining calm and speaking in a gentle, reassuring tone can help reduce anxiety, agitation, or fear. This approach helps the individual feel understood rather than judged, fostering trust and cooperation.

Facilitate professional intervention

Crises often require timely intervention by mental health professionals. Recognising the signs of a crisis and seeking appropriate support, such as contacting a healthcare provider or crisis hotline, ensures the individual receives the care they need, whether it involves medication adjustments, hospitalisation, or additional therapy.

It helps to reiterate the following pointers, almost like a mantra.

1. Stay Calm and Grounded
2. Use clear and simple communication
3. Create a safe environment
4. Know when to seek help
5. Follow up with support

Build a routine

Schizophrenia often involves cognitive challenges, such as difficulty organising thoughts or managing time. A well-structured routine helps with consistency and reduces anxiety about what to expect each day. This also leaves time for caregivers to attend to their personal needs without feeling irritable about having to plan the day for the individual with schizophrenia. 

The most important benefit of having a routine is to adhere to medications. When a medication becomes part of a consistent schedule, such as taking it with meals or before bedtime, it’s easier to remember, reducing the risk of missed doses and potential relapses.

Additionally, it provides a sense of purpose. Having structured activities, such as attending therapy sessions, working, volunteering, or engaging in hobbies, gives individuals a sense of accomplishment and purpose. This helps combat feelings of worthlessness or isolation that often accompany schizophrenia.

Self-care for caregivers

Caregivers’ burden is often an aspect that is overlooked, but the family members providing care for individuals with schizophrenia often face psychological, emotional, and physical stress due to the chronic nature of this illness. Seeking social support should be normalised for the caregivers as well. Practising emotional care by journaling and regularly engaging in at least 1 activity should not be looked at as something shameful. Addressing the caregivers face cognitive burden through difficult decisions helps to focus on other activities and even boundary setting. This improves the quality of care and helps one to be compassionate towards the patients. 

Therapy

Complementing psychiatric consultation with therapy goes a long way to building support and resilience in individuals with schizophrenia. While antipsychotic medications primarily manage symptoms like delusions and hallucinations, therapy focuses on improving functionality, coping mechanisms, relationships, and overall quality of life. Therapy includes sessions that focus on educating about schizophrenia, discussing ways to support the individual, solving practical challenges caused by symptoms, and preparing for crises. The therapy aims to improve understanding and communication within the family, ensuring better support for the person with schizophrenia.

Relapse

Identifying and addressing early warning signs of relapse in individuals with schizophrenia is crucial for preventing symptom escalation and maintaining stability. The symptoms of schizophrenia can be under control through continuous therapy and medication. However, individuals with schizophrenia can go into relapse at any time, which means that their symptoms may come back. Some things to watch out for in case of relapse are;

1. Changes in sleep patterns
2. Lack of appetite
3. Being socially withdrawn
4. Frequent mood changes
5. Neglecting personal hygiene
6. Increased suspicion
7. Reemergence of paranoia or suspicion

To help manage relapse symptoms, encourage them to continue taking their medicine as directed, even if their symptoms get better, because skipping doses might result in relapses. This will help control schizophrenia efficiently. If necessary, accompany them to the doctor to determine the proper medication type and dosage. 

With understanding and a shared commitment from caregivers, clinicians, and communities, we can create an environment that not only reduces stigma but also celebrates progress, encourages growth, and restores dignity to those living with schizophrenia.

H2: Busting 10 Common Myths About Schizophrenia 

Having Schizophrenia means you have dissociative identity disorder (DID)

A common misunderstanding about schizophrenia is that it is dissociative identity disorder (DID), where a person appears to have multiple separate personalities. However, schizophrenia primarily involves symptoms like hallucinations (e.g., hearing voices) and delusions (false beliefs), disorganised speech and behaviours that are not the same as DID.

Most people with schizophrenia are violent or dangerous

Contrary to popular belief, people with schizophrenia are not typically violent, especially when they are under appropriate treatment. They are more often victims of violence and abuse and are at higher risk of self-harm, with suicide rates being high. When violence does occur, it is usually linked to other factors, such as substance abuse or due to the distress caused by untreated symptoms like auditory hallucinations.

Bad parenting is the cause

Researchers aren't sure of what exactly causes schizophrenia, however, there are several contributing factors, including genetics, trauma, and substance abuse. It is generally caused by chemical imbalances and other changes in the brain structures and function. Parenting styles or mistakes cannot lead to schizophrenia.

If a parent has schizophrenia, you'll get it, too

While genetics play a role in schizophrenia, having a parent with the condition doesn’t guarantee you'll develop it. Your risk is higher, but environmental factors like prenatal nutrition or infections can also contribute. If one parent has schizophrenia, your risk is about 10%, and it increases if multiple family members are affected (National Institute of Mental Health, NIMH).

People with schizophrenia aren’t smart 

While people with schizophrenia may struggle with cognitive tasks like attention, learning, and memory, it doesn't mean they lack intelligence. Many highly creative and intelligent individuals throughout history have had the condition, like John Nash (a Nobel prize-winning mathematician whose life was portrayed in the film A Beautiful Mind), Buddy Bolden (pioneer of Jazz music), Elyn Saks (professor of law, psychology and psychiatry), Parveen Babi (a celebrated Indian actress, who struggled with paranoid schizophrenia), Darrell Hammond (a comedian and actor from Saturday Night Live), to name a few.

If you have schizophrenia, you belong in a mental hospital

The care needed for schizophrenia varies based on the severity of symptoms. Many individuals live independently, while others may stay with family or in supportive housing. It is essential to maintain regular contact with a doctor and have a support system in place to manage ongoing treatment.

You can't hold a job if you have schizophrenia

Schizophrenia can make it more challenging to find and maintain a job, but with proper treatment, many individuals can secure positions that align with their skills and abilities.

Schizophrenia makes people lazy

 Having the condition can make it harder for them to do some daily tasks, but this doesn't make them lazy; they just need some help.

It comes on with a sudden psychotic break

While having a psychotic episode happens for some people, for many others the symptoms appear over time and aren't always as noticeable. They might be less social, withdraw more and be less interested in everyday activities.

Schizophrenia can't be treated

While there is no cure for schizophrenia, treatment can manage symptoms and reduce its impact. Although the condition may worsen over time, ongoing treatment is essential. With proper care, many people with schizophrenia lead full, productive lives.

Misunderstanding and Mistreatment of Schizophrenia 

The understanding of schizophrenia has evolved over the years. In the medieval era, individuals exhibiting hallucinations, delusions, and erratic behaviours were often likened to witches or were thought to be possessed by demons. There are early references to schizophrenia in writings that spin a narrative that such individuals were essentially insane and suffered from episodes of madness involving hearing voices, seeing visions, and erratic behaviour. Since people could not fathom the condition of such individuals and were unable to fit it into their existing knowledge and understanding, individuals with schizophrenia were looked at as a burden to society and were ostracised from society. Over the years, people have feared this largely misunderstood population, making it hard to mete out compassionate understanding and care.

Mental asylums and institutions were established where people with schizophrenia were confined, often for many years, and deinstitutionalisation became a problem as they were sometimes kept there for life. Early treatments included treatment with large doses of sedatives, as well as brain surgery or electric shock, which were common but controversial. As the world moved towards the 19th century, Emil Kraepelin, a German psychiatrist, formally described the signs and symptoms of schizophrenia, terming it ‘dementia praecox’ because of the early onset of schizophrenia (around 16 years of age) and the observable chronic deterioration. A Swiss psychiatrist, Eugen Bleuler, later coined the term ‘schizophrenia’, implicating a split in the individual’s psychic functions or thoughts, reality, affect and behaviour. 

In the 1930s, the Nazi regime embarked on a programme to eradicate schizophrenia from the race by the use of euthanasia. It had its origins in the ambitious eugenics movement that aimed to improve the genetic quality of the human population. Initially, this was carried out through lethal injection, but later, gas chambers were introduced as a more efficient method. 

Sometime in the middle of the 20th century, while scientists began developing antihistamine drugs, it was found that certain drugs were effective in controlling psychotic symptoms of schizophrenia, such as hearing voices, seeing things, etc. This was the first generation of the new antipsychotics or neuroleptic drugs called typical antipsychotics.